The Avoidant Patient - A Case Study

Notes of first therapy session with Gladys, female, 26, diagnosed with Avoidant Personality Disorder

"I would like to be normal" - says Gladys and blushes purple. In which sense is she abnormal? She prefers reading books and watching movies with her elderly mother to going out with her colleagues to the occasional office party. Maybe she doesn't feel close to them? How long has she been working with these people? Eight years in the same firm and "not one raise in salary" - she blurts out, evidently hurt. Her boss bullies her publicly and the searing shame of it all prevents her from socializing with peers, suppliers, and clients.

Does she have a boyfriend? I must be mocking her. Who would date an ugly duckling, plain secretary like her? I disagree wholeheartedly and in details with her self-assessment. I think that she is very intelligent. She half rises from her seat then thinks better of it: "Please, doctor, there no need to lie to me just in order to make me feel better. I know my good sides and they don't amount to much. If we disagree on this crucial point, perhaps I should start looking for another therapist."

A glass of water and mounds of tissue paper later, we are back on track. She dreads the idea of group therapy. "I am a social cripple. I can't work with other people. I declined a promotion to avoid working in a team." Her boss thought highly of her until she turned his offer down, so in effect it's all her fault and she has earned the abuse she is being subjected to on a daily basis. And, anyhow, he overestimated her capabilities and skills.

Why can't she interact with her co-workers? "Well, that's precisely what we are supposed to find out, isn't it?" - she retorts. Everyone is too critical and opinionated and she can't stand it. She accepts people as they are, unconditionally - why can't they treat her the same way? She fantasizes about getting married one day to a soulmate, someone who would love and cherish her regardless of her blemishes.

I ask her to describe how she thinks she is being perceived by others. "Shy, timid, lonely, isolated, invisible, quiet, reticent, unfriendly, tense, risk-averse, resistant to change, reluctant, restricted, hysterical, and inhibited." That's quite a list, I comment, now how does she view herself? The same, she largely agrees with people's perceptions of her "but it doesn't give them the right to ridicule or torment her just because she is different."